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IIGN PERMIT APPLICATICS <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plans to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION:(P)425.257.8810 I(E)everettepsteverettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 757, <br /> f 72i4 5-7. S'C PARCEL#: 2 6?) J 73 <br /> CITY r/tleV'.P}'`' STATE t4 ZIP q(9208 <br /> SUITE/UNIT#: (^ ADDITIONAL LOCATION INFORMATION: r <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME: LAY' (74(L - 1 i g.�'ry -rAit <br /> OWNER MAILING ADDRESS: STREET /cf 1?2i..x. cT S� <br /> CITY STATE ZIP / 2O8 <br /> OWNER PHONE: �.2-r?Jig /V OWNER EMAIL: L: j,, z p fr)y-j2 to r J')1 Cm1. <br /> CONTRACTOR CONTACT NAME: '5)7 y r S <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED( .�,be 4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): LD <br /> CONTRACTOR ADDRESS: STREET /9/46 Hui 9p A <br /> r - , 7� <br /> CITY Lyn)"1 7co STATE 14/44. ZIP �J3/)?,a[ <br /> CONTRACTOR PHONE: G-j -.73—//coy "" CONTRACTOR EMAIL: /5� �,!� "�'_r,p, V <br /> PRIMARY CONTACT: C]OWNER LYi CONTRACTOR 0 OTHER(Please Specify) '�"' <br /> CONTACT NAME: CONTACT PHONE: —�� �® / <br /> jit poex q CONTACT EMAIL: --pr r045 I 7,6L.D0 , Cor" <br /> SIGN PERMIT INFORMATION <br /> VALUATION OF WORK:$ p U O ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall Include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> DESCRIPTION OF WORK: <br /> rS-I I CLAM h Lekr v-S eTh -tile w I <br /> SIGN DIMENSIONS: <br /> Sign 1: Width: /99 ' Height: )-3 Square Feet: �- <br /> Sign 2: Width: / Height: Square Feet: <br /> Sign 3: Width: / Height: Square Feet: <br /> SIGN TYPE&QUANTITY: [ VaII/Awning/Canopy-Qty: DWindow-Qty: DElectronic Changing Message-Qty: <br /> OProjecting-Qty: ❑Freestanding-Qty: -Type(monument,etc.): <br /> SIGN UGHTING: ❑Non-Iluminated Illuminated-Type(backlit cabinet,etc.): �: *requires a separate electrical permit <br /> PLAN REVIEW REQUIREMENTS:Submit 2 hard copies of sign plans with permit application to Permit Intake Drop Box. <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> J � PERMIT# 1 <br /> /0 --12--2) 2, p 10 00,3 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> I <br />